Winter warning: managing risk in health and care this winter

Winter Warning highlights the worries of many NHS trusts that extra funding for social care, partly allocated to ease winter pressure on the health service, is not consistently getting through to the NHS.

The report sets out in detail how the NHS responded earlier this year to what many consider to be the toughest winter on record. Despite extraordinary efforts from staff, the health and care systems struggled to cope under sustained pressure.

A key factor was the sharp rise in delayed transfers of care (DTOCs), for patients who were ready to be discharged, often because of difficulties in lining up suitable social care.

The government’s response in the spring budget was to use the £1 billion of extra social care funding for the current financial year to try to reduce social care-related NHS DTOCs, and so ease pressure on trusts.

The clear message in Winter Warning is that, in many places, this is not happening.

Survey key findings

Our member survey shows that only 28% of trusts have been able to secure a commitment from their local authority that the extra social care funding will be spent in a way that directly reduces DTOCs and frees up NHS capacity.

The survey also shows that only 18% of trusts believe they have a commitment that will enable them to deliver the NHS mandate requirement of reducing DTOCs to 3.5%.

Trusts report a lack of capacity across all parts of the health and care system to deal with the expected demand: 64% of trusts report a lack of ambulance capacity; 71% a lack of acute capacity; 76% a lack of community capacity; 80% a lack of mental health capacity; 91% a lack of social care capacity and 92% a lack of primary care capacity.

What more do NHS providers need to manage risk safely

To manage next winter’s risk safely, the NHS needs the added capacity that the extra social care investment was intended, but is failing, to secure. This requires an extra winter pressures funding injection of £350m.

Any extra funding must be committed by the end of July at the latest. It should be funded by a repayable advance on or early draw down of the extra £8bn committed to the NHS in the Conservative manifesto.

Trusts also need flexibility on agency spending over the winter period; more support for better cross health and care sector resilience planning; simplified SITREP reporting; and a shift of NHS England and NHS Improvement activity from assurance to support.

We need a longer-term, sustainable approach to urgent and emergency care that avoids the annual cycle of winter crisis. This includes funding growth that matches demand growth; capital investment to grow infrastrcture to meet growing demand; a comprehensive workforce strategy to tackle workforce shortages; and better planning, focusing on prevention rather than crisis management.

In looking at all these short and long-term solutions, we must adopt a whole system approach. Too often winter pressures has just been about acute hospital capacity. Last winter showed that ambulance, community and mental health capacity are just as important, as is primary and social care capacity.